Types of Treatment Continued

Rashmi Nemade, Ph.D., edited by Kathryn Patricelli, MA

Today, inpatient hospitalization does not normally involve a long stay in the hospital. The goal is to return to the person to a less intensive level of care as quickly as possible. Forty years ago, patients might have stayed in the hospital for months when receiving treatment for depression. Now it is rare to stay for longer than several weeks, and many people stay less than one week. Patients released from the hospital are often transferred to additional (but less intensive) settings such as outpatient care or partial daytime hospitalization. This is done to make sure people continue to get ongoing care that is needed. Treatment is typically coordinated prior to release from the hospital so that it can pick up immediately where hospital care leaves off.

There is no single therapy that works equally well for every person with depression. People suffering from depression should keep this in mind and work with a doctor to find the treatment that works best for them. There are a wide variety of antidepressant medications and types of psychotherapy available today that can be used to treat depressive disorders. Some people with milder forms of depression may do well with psychotherapy alone. Other people with moderate to severe depression most often benefit from medication initially and then psychotherapy after they have taken the medication for a period of time. Most people do best with combination treatment. Medication is used to gain relatively quick symptom relief. Then psychotherapy is started to teach effective coping skills necessary to change depressive thoughts and behaviors and enable long-term recovery.

Though treatments offer the promise of relief from depressive symptoms, they come with side effects and other potential disadvantages as well. Medications generally take weeks before they will have a noticeable effect. Most medications come with unpleasant or at least inconvenient side effects, including weight gain or sexual side effects where it may be difficult to have an orgasm. Psychotherapy requires time and commitment before it can help to relieve symptoms. It can be expensive for people who don't have adequate mental health insurance coverage. Electroconvulsive therapy (see explanation later in this center) generally causes temporary memory loss. It is a good idea to talk to a doctor about the pros and cons associated with the treatments that have been recommended.

Theoretically, treatment can be divided into three phases: the acute phase, the continuance phase, and the maintenance phase. There are no sharp lines dividing the phases. Very few people take a straight and unblocked path through them. The acute phase of treatment is primarily focused on symptom relief. Generally, symptoms decrease in severity within 6 to 12 weeks, but some people take longer before they notice relief. During the continuation phase, the person with depression and the clinician work together to maximize symptom improvements. Further treatment adjustments, such as modifying the dosage of medication, may occur during this period, which can last four to nine months.

By the end of the continuation phase, the patient has (theoretically) experienced maximal symptom improvement, and is hopefully doing well. The maintenance phase is structured around relapse prevention. Ongoing maintenance treatment may be necessary, especially if a patient has recurrent depressive episodes. It can also be necessary when they have a chronic low mood or risk factors that make a recurrence more likely. The maintenance phase can last a long time, sometimes even a lifetime. Making and sustaining healthy lifestyle changes can mean the difference between recurring episodes and a balanced maintenance phase during which depressive relapses do not occur. Exactly what lifestyle changes tend to be helpful in stabilizing treatment maintenance are discussed in more depth in a later section of this center.

By the end of the continuation phase, the patient has (theoretically) experienced maximal symptom improvement, and is hopefully doing well. The maintenance phase is therefore structured around relapse prevention. Ongoing maintenance treatment may be necessary, especially if a patient has recurrent depressive episodes, has chronic low mood, or risk factors that make a recurrence more likely. The maintenance phase can last a long time, sometimes even a lifetime. As mentioned previously, making and sustaining healthy lifestyle changes can mean the difference between recurring episodes and a balanced maintenance phase during which depressive relapses do not occur. Exactly what lifestyle changes tend to be helpful in stabilizing treatment maintenance are discussed in more depth in a later section of this document.